Malignant HTN

Question 1

What is a hypertensive emergency?

Answer 1

This is severe HTN (>180/120 mmHg) with evidence of new or worsening end-organ damage, this is also known as malignant HTN.

Question 2

What is a hypertensive urgency?

Answer 2

This is severe HTN (>180 and/or 110 mmHg) but the patient is stable with no evidence of acute or impending change in end-organ damage or dysfunction.

Question 3

Complications of hypertensive emergencies

Answer 3

Hypertensive encephalopathy
Hypertensive left ventricular failure
Acute aortic dissection

Question 4

Causes of hypertensive emergencies

Answer 4

History of high blood pressure. It’s also more common in African-Americans, males, and people who smoke. It’s especially common in people whose blood pressure is already above 140/90 mm Hg.
Some health conditions increase your chances of having a hypertensive emergency. These include:
-kidney disorders or kidney failure
-the use of drugs such as cocaine, amphetamines, birth control pills, or monoamine oxidase inhibitors (MAOIs)
-pregnancy
-preeclampsia, which is common after 20 weeks gestation, but can sometimes occur earlier in pregnancy or even postpartum
-autoimmune diseases
-spinal cord injuries causing parts of the nervous system to become overactive
-renal stenosis, which is a narrowing of the arteries of the kidneys
-a narrowing of the aorta, the main blood vessel leaving the heart
-not taking your medication for high blood pressure

Question 5

Management of hypertensive emergencies

Answer 5

It should be in the ICU with a controlled gradual reduction in BP.
There should be a full blood profile and urine analysis to detect underlying cause.

Question 6

Signs and symptoms of hypertensive encephalopathy

Answer 6

Headache 
Vomiting 
Visual disturbance 
Mental status changes 
Seizure 
Papilloedema

Question 7

Signs and symptoms of hypertensive LV failure

Answer 7

SOB 
Pulmonary oedema 
Lethargy 
PND
Orthopnoea

Question 8

Signs and symptoms of acute aortic dissection?

Answer 8

Acute severe chest pain
Radiate to back or jaw
Syncope, altered cognition, anxiety.

Question 9

What is fibromuscular dysplasia (FMD)?

Answer 9

This is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery.
The “string-of-beads” appearance is a characteristic feature of medial fibromuscular dysplasia involving the renal vessels. This appearance is caused by areas of stenosis alternating with small aneurysms, the diameters of which exceed the normal diameter of the artery.
This is a secondary cause of hypertension.

Question 10

How is the aldosterone: renin ratio used to determine the difference between primary and secondary hyperaldosteronism?

Answer 10

Primary: 
Increased aldosterone 
Decreased renin
Secondary: 
Increased aldosterone and renin